- Traveling where appropriate to expand/review the existing Networks. - Conduct miscellaneous provider visits; either officially or as mystery shoppers, to ensure compliance with the Insurance Authority’s criteria, audit files, review the standard of care available at the provider sites and to match it with the empanelment criteria. Report and detect any fraud or non-compliance aspects. - Conduct miscellaneous provider visits; either officially or as mystery shoppers, to ensure compliance with the Insurance Authority’s criteria, audit files, review the standard of care available at the provider sites and to match it with the empanelment criteria. Report and detect any fraud or non-compliance aspects. - Apply due diligence while handling the Providers’ Empanelment Process as per the company policies and procedures. - Periodic coordination with HOD Provider Network on the current providers' price list and agreed discounts and pricing of Networks. Review, compare and negotiate prices offered by Providers. - Deploy scrutiny while obtaining the providers' database information on prices, List of medical practitioners, memberships, affiliation and licensing documents, discounts, contact details…etc. Ensure that all information is up to date on systems. - Ensuring that new providers receive a comprehensive training on company policies and procedures, systems, EDI, submission, billing, and other processes. Provide refresher trainings to providers as and when needed. - Respond, to all payers’ queries and requests related to networks; providing the payers when required with any report related to networks. - To be accessible and responsive to providers and staff’s queries and concerns. - Closely monitoring workflow and regular revision for resolving suspended claims/outstanding amounts (reconciliation) with medical providers.